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Bulte CSE, Mansvelder FJ, Loer SA, Bloemers FW, Den Hartog D, Van Lieshout EMM, Hoogerwerf N, van der Naalt J, Absalom AR, Peerdeman SM, Giannakopoulos GF, Schwarte LA, Schober P, Bossers SM. Effect of Daytime versus Nighttime on Prehospital Care and Outcomes after Severe Traumatic Brain Injury. J Clin Med 2024; 13:2249. [PMID: 38673522 PMCID: PMC11051010 DOI: 10.3390/jcm13082249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background/Objectives: Severe traumatic brain injury (TBI) is a frequent cause of morbidity and mortality worldwide. In the Netherlands, suspected TBI is a criterion for the dispatch of the physician-staffed helicopter emergency medical services (HEMS) which are operational 24 h per day. It is unknown if patient outcome is influenced by the time of day during which the incident occurs. Therefore, we investigated the association between the time of day of the prehospital treatment of severe TBI and 30-day mortality. Methods: A retrospective analysis of prospectively collected data from the BRAIN-PROTECT study was performed. Patients with severe TBI treated by one of the four Dutch helicopter emergency medical services were included and followed up to one year. The association between prehospital treatment during day- versus nighttime, according to the universal daylight period, and 30-day mortality was analyzed with multivariable logistic regression. A planned subgroup analysis was performed in patients with TBI with or without any other injury. Results: A total of 1794 patients were included in the analysis, of which 1142 (63.7%) were categorized as daytime and 652 (36.3%) as nighttime. Univariable analysis showed a lower 30-day mortality in patients with severe TBI treated during nighttime (OR 0.74, 95% CI 0.60-0.91, p = 0.004); this association was no longer present in the multivariable model (OR 0.82, 95% CI 0.59-1.16, p = 0.262). In a subgroup analysis, no association was found between mortality rates and the time of prehospital treatment in patients with combined injuries (TBI and any other injury). Patients with isolated TBI had a lower mortality rate when treated during nighttime than when treated during daytime (OR 0.51, 95% CI 0.34-0.76, p = 0.001). Within the whole cohort, daytime versus nighttime treatments were not associated with differences in functional outcome defined by the Glasgow Outcome Scale. Conclusions: In the overall study population, no difference was found in 30-day mortality between patients with severe TBI treated during day or night in the multivariable model. Patients with isolated severe TBI had lower mortality rates at 30 days when treated at nighttime.
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Affiliation(s)
- Carolien S. E. Bulte
- Department of Anesthesiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (F.J.M.); (S.A.L.); (L.A.S.); (P.S.); (S.M.B.)
- Helicopter Emergency Medical Service Lifeliner 1, 1045 AR Amsterdam, The Netherlands;
| | - Floor J. Mansvelder
- Department of Anesthesiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (F.J.M.); (S.A.L.); (L.A.S.); (P.S.); (S.M.B.)
| | - Stephan A. Loer
- Department of Anesthesiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (F.J.M.); (S.A.L.); (L.A.S.); (P.S.); (S.M.B.)
| | - Frank W. Bloemers
- Department of Surgery, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Dennis Den Hartog
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (D.D.H.); (E.M.M.V.L.)
| | - Esther M. M. Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (D.D.H.); (E.M.M.V.L.)
| | - Nico Hoogerwerf
- Department of Anesthesiology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
- Helicopter Emergency Medical Service Lifeliner 3, 5408 SM Volkel, The Netherlands
| | - Joukje van der Naalt
- Department of Neurology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Anthony R. Absalom
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Saskia M. Peerdeman
- Department of Neurosurgery, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Georgios F. Giannakopoulos
- Helicopter Emergency Medical Service Lifeliner 1, 1045 AR Amsterdam, The Netherlands;
- Department of Surgery, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Lothar A. Schwarte
- Department of Anesthesiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (F.J.M.); (S.A.L.); (L.A.S.); (P.S.); (S.M.B.)
- Helicopter Emergency Medical Service Lifeliner 1, 1045 AR Amsterdam, The Netherlands;
| | - Patrick Schober
- Department of Anesthesiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (F.J.M.); (S.A.L.); (L.A.S.); (P.S.); (S.M.B.)
- Helicopter Emergency Medical Service Lifeliner 1, 1045 AR Amsterdam, The Netherlands;
| | - Sebastiaan M. Bossers
- Department of Anesthesiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (F.J.M.); (S.A.L.); (L.A.S.); (P.S.); (S.M.B.)
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Endeshaw AS, Dejen ET, Zewdie BW, Addisu BT, Molla MT, Kumie FT. Perioperative mortality among trauma patients in Northwest Ethiopia: a prospective cohort study. Sci Rep 2023; 13:22859. [PMID: 38129464 PMCID: PMC10739862 DOI: 10.1038/s41598-023-50101-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
Trauma is the leading cause of mortality in persons under 45 and a significant public health issue. Trauma is the most frequent cause of perioperative mortality among all surgical patients. Little is known about perioperative outcomes among trauma patients in low-income countries. This study aimed to assess the incidence and identify predictors of perioperative mortality among adult trauma victims at Tibebe Ghion Specialised Hospital. From June 1, 2019, to June 30, 2021, a prospective cohort study was conducted at Tibebe Ghion Specialized Hospital. Demographic, pre-hospital and perioperative clinical data were collected using an electronic data collection tool, Research Electronic Data Capture (REDCap). Cox proportional hazard model regression was used to assess the association between predictors and perioperative mortality among trauma victims. Crude and adjusted hazard ratio (HR) with a 95% confidence interval (CI) was computed; a p-value < 0.05 was a cutoff value to declare statistical significance. One thousand sixty-nine trauma patients were enrolled in this study. The overall incidence of perioperative mortality among trauma patients was 5.89%, with an incidence rate of 2.23 (95% CI 1.74 to 2.86) deaths per 1000 person-day observation. Age ≥ 65 years (AHR = 2.51, 95% CI: 1.04, 6.08), patients sustained blunt trauma (AHR = 3.28, 95% CI: 1.30, 8.29) and MVA (AHR = 2.96, 95% CI: 1.18, 7.43), trauma occurred at night time (AHR = 2.29, 95% CI: 1.15, 4.56), ASA physical status ≥ III (AHR = 3.84, 95% CI: 1.88, 7.82), and blood transfusion (AHR = 2.01, 95% CI: 1.08, 3.74) were identified as a significant predictor for perioperative mortality among trauma patients. In this trauma cohort, it was demonstrated that perioperative mortality is a healthcare burden. Risk factors for perioperative mortality among trauma patients were old age, patients sustaining blunt trauma and motor vehicle accidents, injuries at night, higher ASA physical status, and blood transfusion. Trauma care services need improvement in pre-hospital and perioperative care.
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Affiliation(s)
- Amanuel Sisay Endeshaw
- Department of Anesthesia, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Eshetu Tesfaye Dejen
- Department of Anesthesia, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Bekalu Wubshet Zewdie
- Department of Orthopedics and Traumatology, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Biniyam Teshome Addisu
- Department of Orthopedics and Traumatology, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Misganew Terefe Molla
- Department of Anesthesia, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Fantahun Tarekegn Kumie
- Department of Anesthesia, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
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Taylor J, Gezer R, Ivkov V, Erdogan M, Hejazi S, Green R, Tallon JM, Tuyp B, Thakore J, Engels PT, Ackery A, Beckett A, Vogt K, Parry N, Heyd C, Coates A, Lampron J, MacPhail I. Do patient outcomes differ when the trauma team leader is a surgeon or non-surgeon? A multicentre cohort study. CAN J EMERG MED 2023:10.1007/s43678-023-00516-z. [PMID: 37184823 DOI: 10.1007/s43678-023-00516-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/21/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE Trauma team leaders (TTLs) have traditionally been general surgeons; however, some trauma centres use a mixed model of care where both surgeons and non-surgeons (primarily emergency physicians) perform this role. The objective of this multicentre study was to provide a well-powered study to determine if TTL specialty is associated with mortality among major trauma patients. METHODS Data were collected from provincial trauma registries at six level 1 trauma centres across Canada over a 10-year period. We included adult trauma patients (age ≥ 18 yrs) who triggered the highest-level trauma activation. The primary outcome was the difference in risk-adjusted in-hospital mortality for trauma patients receiving initial care from a surgeon versus a non-surgeon TTL. RESULTS Overall, 12,961 major trauma patients were included in the analysis. Initial treatment was provided by a surgeon TTL in 57.8% (n = 7513) of cases, while 42.2% (n = 5448) of patients were treated by a non-surgeon TTL. Unadjusted mortality occurred in 11.6% of patients in the surgeon TTL group and 12.7% of patients in the non-surgeon TTL group (OR 0.87, 95% CI 0.78-0.98, p = 0.02). Risk-adjusted mortality was not significantly different between patients cared for by surgeon and non-surgeon TTLs (OR 0.92, 95% CI 0.80-1.06, p = 0.23). Furthermore, we did not observe differences in risk-adjusted mortality for any of the subgroups evaluated. CONCLUSIONS After risk adjustment, there was no difference in mortality between trauma patients treated by surgeon or non-surgeon TTLs. Our study supports emergency physicians performing the role of TTL at level 1 trauma centres.
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Affiliation(s)
- John Taylor
- Royal Columbian Hospital Emergency Department, New Westminster, BC, Canada.
| | | | - Vesna Ivkov
- Emergency and Trauma, Fraser Health Authority, Surrey, BC, Canada
| | - Mete Erdogan
- NS Health Trauma Program, Implementation Science, Nova Scotia Health, Halifax, NS, Canada
| | - Samar Hejazi
- Department of Evaluation and Research Services, Fraser Health Authority, Surrey, BC, Canada
| | - Robert Green
- Departments of Critical Care, Emergency Medicine, Anesthesia, and Surgery, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Trauma Program, Nova Scotia Health, Halifax, NS, Canada
| | - John M Tallon
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
- Departments of Community Health and Epidemiology, Anesthesia and Surgery, Dalhousie University, Halifax, NS, Canada
| | | | - Jaimini Thakore
- Data, Evaluation and Analytics, Trauma Services BC, Fort Langley, BC, Canada
| | - Paul T Engels
- Trauma, General Surgery and Critical Care, Trauma and Acute Care Surgery, McMaster University, Hamilton, ON, Canada
| | - Alun Ackery
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Trauma and Neurosurgery, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Andrew Beckett
- University of Toronto, Toronto, ON, Canada
- Canadian Forces Health Services, Ottawa, ON, Canada
| | - Kelly Vogt
- Western University, London, ON, Canada
- Trauma Program, London Health Sciences Centre, London, ON, Canada
| | - Neil Parry
- Trauma Program, Surgery and Critical Care Medicine, Departments of Surgery and Medicine, Schulich School of Medicine and Dentistry, London Health Sciences Centre, Western University, London, ON, Canada
| | - Christopher Heyd
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Angela Coates
- Trauma Program Manager, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Jacinthe Lampron
- General Surgery, Acute Care and Trauma, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Iain MacPhail
- Fraser Health Trauma Network, UBC, Vancouver, BC, Canada
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García-Tornel Á, Flores A, Terceño M, Cardona P, Amaro S, Gomis M, Zaragoza J, Krupinski J, Gómez-Choco M, Mas N, Cocho D, Catena E, Purroy F, Deck M, Rubiera M, Pagola J, Rodriguez-Luna D, Juega J, Rodríguez-Villatoro N, Molina CA, Soro C, Jimenez X, Salvat-Plana M, Dávalos A, Jovin TG, Abilleira S, Pérez de la Ossa N, Ribó M. Association of Time of Day With Outcomes Among Patients Triaged for a Suspected Severe Stroke in Nonurban Catalonia. Stroke 2023; 54:770-780. [PMID: 36848432 DOI: 10.1161/strokeaha.122.041013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND We aim to assess whether time of day modified the treatment effect in the RACECAT trial (Direct Transfer to an Endovascular Center Compared to Transfer to the Closest Stroke Center in Acute Stroke Patients With Suspected Large Vessel Occlusion Trial), a cluster-randomized trial that did not demonstrate the benefit of direct transportation to a thrombectomy-capable center versus nearest local stroke center for patients with a suspected large vessel stroke triaged in nonurban Catalonia between March 2017 and June 2020. METHODS We performed a post hoc analysis of RACECAT to evaluate if the association between initial transport routing and functional outcome differed according to trial enrollment time: daytime (8:00 am-8:59 pm) and nighttime (9:00 pm-7:59 am). Primary outcome was disability at 90 days, as assessed by the shift analysis on the modified Rankin Scale score, in patients with ischemic stroke. Subgroup analyses according to stroke subtype were evaluated. RESULTS We included 949 patients with an ischemic stroke, of whom 258 patients(27%) were enrolled during nighttime. Among patients enrolled during nighttime, direct transport to a thrombectomy-capable center was associated with lower degrees of disability at 90 days (adjusted common odds ratio [acOR], 1.620 [95% CI, 1.020-2.551]); no significant difference between trial groups was present during daytime (acOR, 0.890 [95% CI, 0.680-1.163]; P
interaction=0.014). Influence of nighttime on the treatment effect was only evident in patients with large vessel occlusion(daytime, acOR 0.766 [95% CI, 0.548-1.072]; nighttime, acOR, 1.785 [95% CI, 1.024-3.112] ; P
interaction<0.01); no heterogeneity was observed for other stroke subtypes (P
interaction>0.1 for all comparisons). We observed longer delays in alteplase administration, interhospital transfers, and mechanical thrombectomy initiation during nighttime in patients allocated to local stroke centers. CONCLUSIONS Among patients evaluated during nighttime for a suspected acute severe stroke in non-urban areas of Catalonia, direct transport to a thrombectomy-capable center was associated with lower degrees of disability at 90 days. This association was only evident in patients with confirmed large vessel occlusion on vascular imaging. Time delays in alteplase administration and interhospital transfers might mediate the observed differences in clinical outcome. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02795962.
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Affiliation(s)
- Álvaro García-Tornel
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (A.G.-T., M.D., M. Rubiera., J.P., D.R.L., J.J., N.R.V., C.A.M., M. Ribó)
| | - Alan Flores
- Department of Neurology, Hospital Universitari Joan XXIII, Tarragona, Spain (A.F.)
| | - Mikel Terceño
- Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T.)
| | - Pedro Cardona
- Stroke Unit, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Spain (P.C.)
| | - Sergi Amaro
- Stroke Unit, Hospital Clínic, Barcelona, Spain (S.A.)
| | - Meritxell Gomis
- Stroke Unit, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (M.G., A.D., N.P.d.l.O.)
| | - Josep Zaragoza
- Department of Neurology, Hospital Verge de la Cinta, Tortosa, Spain (J.Z.)
| | - Jerzy Krupinski
- Department of Neurology, Hospital Mútua Terrassa, Spain (J.K.)
| | - Manuel Gómez-Choco
- Department of Neurology, Hospital Moisés Broggi, Sant Joan Despí, Spain (M.G.-C.)
| | - Natalia Mas
- Department of Neurology, Hospital Sant Joan de Déu - Fundació Althaia, Manresa, Spain (N.M.)
| | - Dolores Cocho
- Department of Neurology, Hospital General Granollers, Spain (D.C.)
| | - Esther Catena
- Department of Neurology, Consorci Sanitari Alt Penedès-Garraf, Spain (E.C.)
| | - Francesc Purroy
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P.)
| | - Matias Deck
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (A.G.-T., M.D., M. Rubiera., J.P., D.R.L., J.J., N.R.V., C.A.M., M. Ribó)
| | - Marta Rubiera
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (A.G.-T., M.D., M. Rubiera., J.P., D.R.L., J.J., N.R.V., C.A.M., M. Ribó)
| | - Jorge Pagola
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (A.G.-T., M.D., M. Rubiera., J.P., D.R.L., J.J., N.R.V., C.A.M., M. Ribó)
| | - David Rodriguez-Luna
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (A.G.-T., M.D., M. Rubiera., J.P., D.R.L., J.J., N.R.V., C.A.M., M. Ribó)
| | - Jesús Juega
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (A.G.-T., M.D., M. Rubiera., J.P., D.R.L., J.J., N.R.V., C.A.M., M. Ribó)
| | - Noelia Rodríguez-Villatoro
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (A.G.-T., M.D., M. Rubiera., J.P., D.R.L., J.J., N.R.V., C.A.M., M. Ribó)
| | - Carlos A Molina
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (A.G.-T., M.D., M. Rubiera., J.P., D.R.L., J.J., N.R.V., C.A.M., M. Ribó)
| | - Cristina Soro
- Sistema d'Emergències Mèdiques, Barcelona, Spain (C.S., X.J.)
| | - Xavier Jimenez
- Sistema d'Emergències Mèdiques, Barcelona, Spain (C.S., X.J.)
| | - Mercè Salvat-Plana
- Stroke Program, Catalan Health Department, Agency for Health Quality and Assesment of Catalonia (AQuAS), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain (M.S.-P., S.A.)
| | - Antoni Dávalos
- Stroke Unit, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (M.G., A.D., N.P.d.l.O.)
| | - Tudor G Jovin
- Neurological Institute, Cooper University Hospital, Camden, NJ (T.G.J.)
| | - Sonia Abilleira
- Stroke Program, Catalan Health Department, Agency for Health Quality and Assesment of Catalonia (AQuAS), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain (M.S.-P., S.A.)
| | - Natalia Pérez de la Ossa
- Stroke Unit, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (M.G., A.D., N.P.d.l.O.)
| | - Marc Ribó
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (A.G.-T., M.D., M. Rubiera., J.P., D.R.L., J.J., N.R.V., C.A.M., M. Ribó)
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Otaka S, Ohbe H, Igeta R, Chiba T, Ikeda S, Shiga T. Factors Associated with an Increase in On-Site Time of Pediatric Trauma Patients in a Prehospital Setting: A Nationwide Observational Study in Japan. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1658. [PMID: 36360384 PMCID: PMC9688461 DOI: 10.3390/children9111658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
The factors that prolong the on-site time in pediatric trauma cases in a prehospital setting are unknown. We investigated these factors using a national trauma registry in Japan. We identified pediatric trauma patients aged ≤18 years, from January 2004 to May 2019. We categorized cases into shorter (≤13 min) and longer (>13 min) prehospital on-site time groups. We performed multivariable logistic regression analysis with multiple imputations to assess the factors associated with longer prehospital on-site time. Overall, 14,535 patients qualified for inclusion. The median prehospital on-site time was 13 min. In the multivariable logistic regression analysis, the longer prehospital on-site time was associated with higher age; suicide (Odds ratio [OR] 1.27; 95% confidence interval [CI] 1.03−1.57); violence (OR 1.74; 95%CI 1.27−2.38); higher revised trauma score, abbreviated injury scale > 3 in the spine (OR 1.25; 95%CI 1.04−1.50), upper extremity (OR 1.26; 95%CI 1.11−1.44), and lower extremity (OR 1.25; 95%CI 1.14−1.37); immobilization (OR 1.16; 95%CI 1.06−1.27); and comorbid mental retardation (OR 1.56; 95%CI 1.11−2.18). In light of these factors, time in the field could be reduced by having more pediatric emergency physicians and orthopedic surgeons available.
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Affiliation(s)
- Shunichi Otaka
- Department of Emergency Medicine, International University of Health and Welfare Narita Hospital, Chiba 286-8520, Japan
- Graduate School of Medicine, International University of Health and Welfare, Chiba 324-8501, Japan
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo 113-8654, Japan
| | - Ryuhei Igeta
- Department of Emergency Medicine, International University of Health and Welfare Narita Hospital, Chiba 286-8520, Japan
- Graduate School of Medicine, International University of Health and Welfare, Chiba 324-8501, Japan
| | - Takuyo Chiba
- Department of Emergency Medicine, International University of Health and Welfare Narita Hospital, Chiba 286-8520, Japan
- Graduate School of Medicine, International University of Health and Welfare, Chiba 324-8501, Japan
| | - Shunya Ikeda
- Department of Public Health, School of Medicine, International University of Health and Welfare, Chiba 324-8501, Japan
| | - Takashi Shiga
- Department of Emergency Medicine, International University of Health and Welfare Narita Hospital, Chiba 286-8520, Japan
- Graduate School of Medicine, International University of Health and Welfare, Chiba 324-8501, Japan
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6
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Ying Y, Huang B, Zhu Y, Jiang X, Dong J, Ding Y, Wang L, Yuan H, Jiang P. Comparison of Five Triage Tools for Identifying Mortality Risk and Injury Severity of Multiple Trauma Patients Admitted to the Emergency Department in the Daytime and Nighttime: A Retrospective Study. Appl Bionics Biomech 2022; 2022:9368920. [PMID: 35251304 PMCID: PMC8896924 DOI: 10.1155/2022/9368920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 11/18/2022] Open
Abstract
Effective triage tools are indispensable for doctors to make a prompt decision for the treatment of multiple trauma patients in emergency departments (EDs). The Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), standardized early warning score (SEWS), Modified Rapid Emergency Medicine Score (mREMS), and Revised Trauma Score (RTS) are five common triage tools proposed for trauma management. However, few studies have compared these tools in a multiple trauma cohort and investigated the influence of nighttime admission on the performance of these tools. This retrospective study was aimed at evaluating and comparing the performance of MEWS, NEWS, SEWS, mREMS, and RTS for identifying the mortality risk and trauma severity of patients with multiple trauma admitted to the ED during the daytime and nighttime. Retrospective data were collected from the medical records of patients with multiple trauma admitted in the daytime or nighttime to calculate scores for each triage tool. Logistic regression analysis was conducted on each triage tool for identifying in-hospital mortality and severe trauma (injury severity score > 15) in the daytime and nighttime. The performance of the tools was evaluated and compared by calculating area under the receiver operating characteristic curve (AUROC) of the retrospective logistic model of each tool. We collected data for 1,818 admissions, including 1,070 daytime and 748 nighttime admissions. A comparison of performance for identifying in-hospital mortality between daytime and nighttime yielded the following results (AUROC): MEWS (0.95 vs. 0.93, p = 0.384), NEWS (0.95 vs. 0.94, p = 0.708), SEWS (0.95 vs. 0.94, p = 0.683), mREMS (0.94 vs. 0.92, p = 0.286), and RTS (0.93 vs. 0.93, p = 0.87). Similarly, a comparison of performance for identifying trauma severity between daytime and nighttime yielded the following results (AUROC): MEWS (0.78 vs. 0.78, p = 0.95), NEWS (0.8 vs. 0.8, p = 0.885), SEWS (0.78 vs. 0.78, p = 0.818), mREMS (0.75 vs. 0.69, p = 0.019), and RTS (0.75 vs. 0.74, p = 0.619). All five scores are excellent triage tools (AUROC ≥ 0.9) for identifying in-hospital mortality for both daytime and nighttime admissions. However, they have only moderate effectiveness (AUROC < 0.9) at identifying severe trauma. The NEWS is the best triage tool for identifying severe trauma for both daytime and nighttime admissions. The MEWS, NEWS, SEWS, and RTS exhibited no significant differences in performance for identifying in-hospital mortality or severe trauma during the daytime or nighttime. However, the mREMS was better at identifying severe trauma during the daytime.
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Affiliation(s)
- Youguo Ying
- Emergency Department 1, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Boli Huang
- Department of Nursing, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Nursing Management Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Zhu
- Department of Nursing, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaobin Jiang
- Emergency Department 1, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinxiu Dong
- Emergency Department 1, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanfen Ding
- Emergency Department 1, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Wang
- Emergency Department 1, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huimin Yuan
- Emergency Department 1, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Nakao S, Katayama Y, Kitamura T, Hirose T, Tachino J, Ishida K, Ojima M, Kiguchi T, Umemura Y, Noda T, Matsuyama T, Kiyohara K, Nakagawa Y. Assessing the impact of the national traffic safety campaign: a nationwide cohort study in Japan. BMJ Open 2022; 12:e054295. [PMID: 35105584 PMCID: PMC8808439 DOI: 10.1136/bmjopen-2021-054295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study aimed to examine the difference in mortality from serious road traffic injuries during the National Traffic Safety Campaign compared with other periods and identify the common mechanisms of injury by age group in Japan. DESIGN A retrospective review of Japan Trauma Data Bank (JTDB). SETTING A total of 280 participating major emergency institutions across Japan. PARTICIPANTS Patients with road traffic injuries registered in JTDB between 2004 and 2018 were recruited in the study. We included patients injured by traffic crashes during the National Traffic Safety Campaigns and controls using a double control method. The National Traffic Safety Campaign comprises 10 consecutive days in spring and fall (20 days in each year), and controls was the same calendar days 2 weeks before and after the days in the National Traffic Safety Campaigns (40 days in each year) to control for weekday, seasonal and yearly trends. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was in-hospital mortality. The secondary outcome was the incidences of severe traffic injury. RESULTS Among 126 857 patients recorded as road traffic injuries in JTDB, we identified 6181 patients (21 cases per day) with injuries occurring during the National Traffic Safety Campaigns and 12 382 controls (21 cases per day). The overall in-hospital mortality was 11.4%. We did not observe a significant difference in in-hospital mortality between the groups (11.8% vs 11.1%) with an adjusted OR of 1.05 (95% CI 0.95 to 1.16). The most common mechanism of injury in each age group was bicycle crash among children, motorcycle crash among adults and pedestrian among the elderly. CONCLUSIONS We found no change in the incidence of severe traffic injury or in-hospital mortality during the National Traffic Safety Campaign in Japan. Serious road trauma was high for bicycles among children, motorcycles among adults and pedestrian among the elderly.
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Affiliation(s)
- Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Faculty of Medicine Graduate School of Medicine, Suita, Osaka, Japan
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Faculty of Medicine Graduate School of Medicine, Suita, Osaka, Japan
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Osaka University Faculty of Medicine Graduate School of Medicine, Suita, Osaka, Japan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine, Osaka University Faculty of Medicine Graduate School of Medicine, Suita, Osaka, Japan
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical Medicine, Osaka University Faculty of Medicine Graduate School of Medicine, Suita, Osaka, Japan
| | - Kenichiro Ishida
- Department of Acute Medicine and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Masahiro Ojima
- Department of Acute Medicine and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takeyuki Kiguchi
- Department of Emergency and Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Yutaka Umemura
- Department of Emergency and Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Tomohiro Noda
- Department of Traumatology and Critical Care Medicine, Osaka City University Graduate School of Medicine School of Medicine, Osaka, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kosuke Kiyohara
- Department of Food Science, Otsuma Women's University, Chiyoda-ku, Tokyo, Japan
| | - Yuko Nakagawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Faculty of Medicine Graduate School of Medicine, Suita, Osaka, Japan
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Jitsuiki K, Nagasawa H, Muramatsu KI, Takeuchi I, Ohsaka H, Ishikawa K, Yanagawa Y. The Usefulness of Physician-Staffed Helicopters for Managing Severe Abdominal Trauma Patients. J Emerg Trauma Shock 2022; 15:12-16. [PMID: 35431489 PMCID: PMC9006718 DOI: 10.4103/jets.jets_96_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/06/2021] [Accepted: 12/21/2021] [Indexed: 11/14/2022] Open
Abstract
Introduction: We retrospectively investigated prognostic factors for severe abdominal trauma patients evacuated by a physician-staffed helicopter emergency medical service (HEMS) and ground ambulance using the Japan Trauma Data Bank (JTDB). Methods: The study period was from January 2004 to May 2019. The subjects were divided into two groups, according to the type of outcome: the Mortality group, which included patients who ultimately died, and the Survival group, which included patients who obtained a survival outcome. Results: There were 2457 in the Mortality group and 11,326 in the Survival group. When variables that showed statistical significance in the univariate analysis were included in a multivariate analysis, the following variables were identified as significant positive predictors of a fatal outcome: evacuation from the scene, blunt injury, injury severity score, and age; significant negative predictors of a fatal outcome were transportation by the HEMS and revised trauma score. Conclusions: The present study described the usefulness of the HEMS for severe abdominal trauma patients in comparison with ground ambulance transportation using the JTDB.
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Affiliation(s)
- Kei Jitsuiki
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan
| | - Hiroki Nagasawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan
| | - Ken-Ichi Muramatsu
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan
| | - Ikuto Takeuchi
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan
| | - Kouhei Ishikawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan
| | - Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan
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Does the time of the day affect multiple trauma care in hospitals? A retrospective analysis of data from the TraumaRegister DGU®. BMC Emerg Med 2021; 21:134. [PMID: 34773984 PMCID: PMC8590232 DOI: 10.1186/s12873-021-00525-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/22/2021] [Indexed: 12/01/2022] Open
Abstract
Background Optimal multiple trauma care should be continuously provided during the day and night. Several studies have demonstrated worse outcomes and higher mortality in patients admitted at night. This study involved the analysis of a population of multiple trauma patients admitted at night and a comparison of various indicators of the quality of care at different admission times. Methods Data from 58,939 multiple trauma patients from 2007 to 2017 were analyzed retrospectively. All data were obtained from TraumaRegister DGU®. Patients were grouped by the time of their admission to the trauma center (6.00 am–11.59 am (morning), 12.00 pm–5.59 pm (afternoon), 6.00 pm–11.59 pm (evening), 0.00 am–5.59 am (night)). Incidences, patient demographics, injury patterns, trauma center levels and trauma care times and outcomes were evaluated. Results Fewer patients were admitted during the night (6.00 pm–11.59 pm: 18.8% of the patients, 0.00–5.59 am: 4.6% of the patients) than during the day. Patients who arrived between 0.00 am–5.59 am were younger (49.4 ± 22.8 years) and had a higher injury severity score (ISS) (21.4 ± 11.5) and lower Glasgow Coma Scale (GCS) score (11.6 ± 4.4) than those admitted during the day (12.00 pm–05.59 pm; age: 55.3 ± 21.6 years, ISS: 20.6 ± 11.4, GCS: 12.6 ± 4.0). Time in the trauma department and time to an emergency operation were only marginally different. Time to imaging was slightly prolonged during the night (0.00 am–5.59 am: X-ray 16.2 ± 19.8 min; CT scan 24.3 ± 18.1 min versus 12.00 pm- 5.59 pm: X-ray 15.4 ± 19.7 min; CT scan 22.5 ± 17.8 min), but the delay did not affect the outcome. The outcome was also not affected by level of the trauma center. There was no relevant difference in the Revised Injury Severity Classification II (RISC II) score or mortality rate between patients admitted during the day and at night. There were no differences in RISC II scores or mortality rates according to time period. Admission at night was not a predictor of a higher mortality rate. Conclusion The patient population and injury severity vary between the day and night with regard to age, injury pattern and trauma mechanism. Despite the differences in these factors, arrival at night did not have a negative effect on the outcome.
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Ota S, Jitsuiki K, Muramatsu KI, Kushida Y, Nagasawa H, Ohsaka H, Omori K, Yanagawa Y. The utility of physician-staffed helicopters for managing individuals who experience severe isolated head trauma. J Rural Med 2021; 16:245-249. [PMID: 34707734 PMCID: PMC8527619 DOI: 10.2185/jrm.2021-016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/28/2021] [Indexed: 11/27/2022] Open
Abstract
Objective: The authors retrospectively investigated prognostic factors for
severe isolated head trauma in patients evacuated by a physician-staffed helicopter
emergency medical service (HEMS) or ground ambulance using data from the Japan Trauma Data
Bank (JTDB). Patients and Methods: This study was a retrospective analysis of data housed
in the JTDB database. The study period was from January 2004 to May 2019. Subjects were
divided into two groups according to the method of transportation: helicopter (i.e.,
HEMS), which included patients transported by a physician-staffed helicopter; and
ambulance, which included patients transported by ground ambulance. Results: A total of 41,358 patients were enrolled in the study, including
2,029 in the helicopter group and 39,329 in the ambulance group. The ratio of males,
median head Abbreviated Injury Scale and Injury Severity Scale (ISS) scores were
significantly greater in the helicopter group than in the ambulance group, while the
average age, median Glasgow Coma Scale, average Revised Trauma Score (RTS), and survival
rate were significantly lower in the helicopter group than in the ambulance group. Of the
variables that demonstrated statistical significance in the univariate analysis and
classification of transportation and included in the multivariate analysis, the following
were identified as significant predictors of survival outcomes: younger age, lower ISS,
female sex, and greater RTS. HEMS was not a significant predictor of survival. Conclusion: The present study revealed no effect of HEMS transport on the
outcomes of patients who experienced severe isolated head trauma compared with ground
ambulance transportation. Further prospective studies, including an analysis of the
operation time or distance traveled by the HEMS and the functional outcome(s) of patients
with severe head injury transported by HEMS, are warranted.
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Affiliation(s)
- Soichiro Ota
- Department of Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Japan
| | - Kei Jitsuiki
- Department of Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Japan
| | - Ken-Ichi Muramatsu
- Department of Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Japan
| | - Yoshihiro Kushida
- Department of Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Japan
| | - Hiroki Nagasawa
- Department of Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Japan
| | - Kazuhiko Omori
- Department of Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Japan
| | - Youichi Yanagawa
- Department of Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Japan
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Riyapan S, Chantanakomes J, Somboonkul B, Shin SD, Chiang WC. Effect of Nighttime on Prehospital Care and Outcomes of Road Traffic Injuries in Asia: A Cross-Sectional Study of Data from the Pan-Asian Trauma Outcomes Study (PATOS). PREHOSP EMERG CARE 2021; 26:573-581. [PMID: 34464227 DOI: 10.1080/10903127.2021.1974990] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: Emergency response to a road traffic injury (RTI) plays a crucial role in patient survival, and the quality of the emergency response should be consistent regardless of the time of day. The aim of this study was to investigate prehospital care and survival outcomes compared between emergency response to RTI during the day and emergency response to RTI at night in Asia.Method: This cross-sectional study used data from the Pan-Asian Trauma Outcome Study (PATOS) that was conducted during 2015-2018. We included RTI patients who were transported to the emergency department (ED) by ground ambulance. That group was then categorized according to the time that the ambulance arrived on-scene. On-scene arrival during 8:00 am to 7:59 pm was defined as the daytime group, and arrival during 8:00 pm to 7:59 am was defined as the nighttime group. Multiple logistic regression was employed to identify factors associated with nighttime prehospital interventions and survival outcomes after adjustment for age, alcohol consumption, and injury severity score (ISS).Results: The final analysis included 20,105 RTI patients. Of those, 12,043 (60%) accidents occurred during the daytime, and 8,062 (40%) occurred at night. RTI patients at night were younger (mean age: 35.7 ± 17.3 vs. 39.5 ± 20.7; p < 0.001), had more alcohol consumption (15.0% vs. 4.2%; p < 0.001), and had more severe injuries (mean ISS: 6.5 ± 7.5 vs. 5.8 ± 7.0; p < 0.001) compared to the daytime group. The nighttime group had increased prehospital immobilization (adjusted odds ratio [aOR]: 1.22, 95% confidence interval [CI]: 1.14-1.31) and more prehospital intravenous (IV) access (aOR 1.36, 95%CI: 1.22-1.51). There was no significant difference in either basic or advanced airway management between the daytime and nighttime groups. The nighttime group had decreased survival in the ED (aOR: 0.80, 95%CI: 0.65-0.98); however, nighttime on-scene arrival did not impact survival to discharge (aOR: 1.10, 95%CI: 0.91-1.33).Conclusion: In the PATOS community, RTI patients that sustained their injuries at night received significantly more prehospital immobilization and IV access, and they had significantly decreased survival in the ED. The results of this study can be used to develop and enhance strategies to improve the care and outcomes of nighttime RTI in Asia.
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Deshmukh US, Lundsberg LS, Culhane JF, Partridge C, Reddy UM, Merriam AA, Son M. Factors associated with appropriate treatment of acute-onset severe obstetrical hypertension. Am J Obstet Gynecol 2021; 225:329.e1-329.e10. [PMID: 34023314 DOI: 10.1016/j.ajog.2021.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/03/2021] [Accepted: 05/07/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The American College of Obstetricians and Gynecologists recommends that pregnant patients receive expeditious treatment with first-line antihypertensive agents within 1 hour of confirmed severe hypertension to reduce the risk for maternal stroke. However, it is unknown how often this guideline is followed and what factors influence a patient's likelihood of receiving guideline-concordant care. OBJECTIVE We aimed to identify factors associated with receiving guideline-concordant treatment for an obstetrical hypertensive emergency. STUDY DESIGN We present a case-control study of all pregnant and postpartum patients who had persistent severe hypertension (≥2 systolic blood pressures ≥160 mm Hg or diastolic blood pressure ≥110 mm Hg, or both within 1 hour of each other) during their delivery hospitalization at a tertiary hospital from October 1, 2013, to August 31, 2020. Data were extracted from the hospital electronic medical records using standard definitions and billing and diagnosis codes. We defined receipt of the recommended treatment as administration of a first-line antihypertensive agent (intravenous labetalol, intravenous hydralazine, or immediate-release oral nifedipine) within 60 minutes of the first or second severe-range blood pressure measurement during their delivery hospitalization. Delayed treatment was defined as the administration of a first-line agent >60 minutes after the second elevated blood pressure measurement. Patients were considered untreated if a first-line agent was never administered. Maternal sociodemographic, clinical and pregnancy factors, and time and day of the week of the hypertensive emergency were compared among patients who received the recommended treatment, those who received delayed treatment, and those who were untreated. Bivariate analyses were performed, and multinomial and multivariable logistic regression models were used to adjust for potential confounders. RESULTS Of the 39,918 deliveries in the cohort, 1987 (5.0%) were complicated by severe, persistent obstetrical hypertension. Of these patients, 532 (26.8%) received the recommended treatment, 356 (17.9%) received delayed treatment, and 1099 (55.3%) did not receive any first-line antihypertensive therapy. The multinomial regression models that were used to compare these 3 groups indicated that patients who received the recommended treatment were more likely to be Black (adjusted odds ratio, 1.85; 95% confidence interval, 1.36-2.51), Hispanic (adjusted odds ratio, 1.77; 95% confidence interval, 1.28-2.52), or pregnant and at <37 weeks of gestation (adjusted odds ratio, 6.65; 95% confidence interval, 5.08-8.72). Treatment was less likely if the severe obstetrical hypertension emergency occurred overnight (7:00 PM to 6:59 AM) (adjusted odds ratio, 0.79; 95% confidence interval, 0.64-0.97) or during the postpartum period (adjusted odds ratio, 0.66; 95% confidence interval, 0.51-0.86). CONCLUSION Approximately half of obstetrical patients with at least 2 documented severely elevated blood pressure measurements did not receive the recommended antihypertensive treatment. Of those who did receive treatment, about 40% had delayed treatment. Black and Hispanic race and preterm gestation were associated with an increased likelihood of receiving the recommended treatment when compared with White race and term pregnancies. Patients whose severe obstetrical hypertension emergency occurred overnight and those who were postpartum were less likely to receive any first-line antihypertensive treatment. Overall, patients without sociodemographic and clinical risk factors for severe obstetrical hypertension or other pregnancy complications were less likely to be treated. However, treatment improved significantly over time with the implementation of targeted quality measures and specific institutional policies based on the American College of Obstetricians and Gynecologists' latest severe obstetrical hypertension management guidelines.
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Affiliation(s)
- Uma S Deshmukh
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT.
| | - Lisbet S Lundsberg
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Jennifer F Culhane
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Caitlin Partridge
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Uma M Reddy
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Audrey A Merriam
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Moeun Son
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
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The Patterns and Impact of Off-Working Hours, Weekends and Seasonal Admissions of Patients with Major Trauma in a Level 1 Trauma Center. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168542. [PMID: 34444291 PMCID: PMC8393594 DOI: 10.3390/ijerph18168542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/22/2022]
Abstract
Background: The trauma incidence follows specific patterns in different societies and is expected to increase over the weekend and nighttime. We aimed to explore and analyze the incidence, pattern, and severity of trauma at different times (working hours vs. out off-working hours, weekdays vs. weekends and season). Methods: A retrospective analysis was conducted at a level 1 trauma facility in Qatar. All injured patients admitted between June 2017 and May 2018 were included. The data were analyzed to determine whether outcomes and care parameters of these patients differed between regular working hours and off-working hours, weekdays vs. weekends, and between season intervals. Results: During the study period, 2477 patients were admitted. A total of 816 (32.9%) patients presented during working hours and 1500 (60.6%) during off-working hours. Off-working hours presentations differed significantly with the injury severity score (ISS) (p < 0.001), ICU length of stay (p = 0.001), blood transfusions (p = 0.001), intubations (p = 0.001), mortality rate (9.7% vs. 0.7%; p < 0.001), and disposition to rehabilitation centers. Weekend presentations were significantly associated with a higher ISS (p = 0.01), Priority 1 trauma activation (19.1% vs. 14.7%; p = 0005), and need for intubation (21% vs. 16%; p = 0.002). The length of stay (ICU and hospital), mortality, and disposition to rehabilitation centers and other clinical parameters did not show any significant differences. No significant seasonal variation was observed in terms of admissions at the trauma center. Conclusions: The off-working hours admission showed an apparent demographic effect in involved mechanisms, injury severity, and trauma activations, while outcomes, especially the mortality rate, were significantly different during nights but not during the weekends. The only observed seasonal effect was a decrease in the number of admissions during the summer break.
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Hosomi S, Kitamura T, Sobue T, Ogura H, Shimazu T. Survival outcomes after traumatic brain injury during national academic meeting days in Japan. Sci Rep 2021; 11:15206. [PMID: 34312458 PMCID: PMC8313689 DOI: 10.1038/s41598-021-94759-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/15/2021] [Indexed: 11/09/2022] Open
Abstract
Surgeons and medical staff attend academic meetings several times a year. However, there is insufficient evidence on the influence of the “meeting effect” on traumatic brain injury (TBI) treatments and outcomes. Using the Japan Trauma Data Bank, we analyzed the data of TBI patients admitted to the hospital from 2004 to 2018 during the national academic meeting days of the Japanese Association for Acute Medicine, the Japanese Society of Intensive Care Medicine, the Japanese Association for the surgery of trauma, the Japan Society of Neurotraumatology and the Japan Neurosurgical Society. The data of these patients were compared with those of TBI patients admitted 1 week before and after the meetings. The primary outcome was in-hospital death. We included 7320 patients in our analyses, with 5139 and 2181 patients admitted during the non-meeting and meeting days, respectively; their in-hospital mortality rates were 15.7% and 14.5%, respectively. No significant differences in in-hospital mortality were found (adjusted odds ratio, 0.93; 95% confidence interval, 0.78–1.11). In addition, there were no significant differences in in-hospital mortality during the meeting and non-meeting days by the type of national meeting. In Japan, it is acceptable for medical professionals involved in TBI treatments to attend national academic meetings without impacting the outcomes of TBI patients.
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Affiliation(s)
- Sanae Hosomi
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15, Yamadaoka, Suita, Osaka, 565-0871, Japan. .,Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, 2-15, Yamadaoka, Suita, Japan.
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, 2-15, Yamadaoka, Suita, Japan
| | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, 2-15, Yamadaoka, Suita, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15, Yamadaoka, Suita, Osaka, 565-0871, Japan
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Goertz L, Kabbasch C, Pflaeging M, Pennig L, Laukamp KR, Timmer M, Styczen H, Brinker G, Goldbrunner R, Krischek B. Impact of the weekend effect on outcome after microsurgical clipping of ruptured intracranial aneurysms. Acta Neurochir (Wien) 2021; 163:783-791. [PMID: 33403431 PMCID: PMC7886827 DOI: 10.1007/s00701-020-04689-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/17/2020] [Indexed: 12/03/2022]
Abstract
BACKGROUND The "weekend effect" describes the assumption that weekend and/or on-call duty admission of emergency patients is associated with increased morbidity and mortality rates. For aneurysmal subarachnoid hemorrhage, we investigated, whether presentation out of regular working hours and microsurgical clipping at nighttime correlates with worse patient outcome. METHODS This is a retrospective review of consecutive patients that underwent microsurgical clipping of an acutely ruptured aneurysm at our institution between 2010 and 2019. Patients admitted during (1) regular working hours (Monday-Friday, 08:00-17:59) and (2) on-call duty and microsurgical clipping performed during (a) daytime (Monday-Sunday, 08:00-17:59) and (b) nighttime were compared regarding the following outcome parameters: operation time, treatment-related complications, vasospasm, functional outcome, and angiographic results. RESULTS Among 157 enrolled patients, 104 patients (66.2%) were admitted during on-call duty and 48 operations (30.6%) were performed at nighttime. Admission out of regular hours did not affect cerebral infarction (p = 0.545), mortality (p = 0.343), functional outcome (p = 0.178), and aneurysm occlusion (p = 0.689). Microsurgical clipping at nighttime carried higher odds of unfavorable outcome at discharge (OR: 2.3, 95%CI: 1.0-5.1, p = 0.039); however, there were no significant differences regarding the remaining outcome parameters. After multivariable adjustment, clipping at nighttime did not remain as independent prognosticator of short-term outcome (OR: 2.1, 95%CI: 0.7-6.2, p = 0.169). CONCLUSIONS Admission out of regular working hours and clipping at nighttime were not independently associated with poor outcome. The adherence to standardized treatment protocols might mitigate the "weekend effect."
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Affiliation(s)
- Lukas Goertz
- Center for Neurosurgery, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
- Department of Neuroradiology, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
| | - Christoph Kabbasch
- Department of Neuroradiology, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Muriel Pflaeging
- Center for Neurosurgery, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Lenhard Pennig
- Department of Neuroradiology, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Kai Roman Laukamp
- Department of Neuroradiology, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Marco Timmer
- Center for Neurosurgery, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Hanna Styczen
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Gerrit Brinker
- Center for Neurosurgery, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Roland Goldbrunner
- Center for Neurosurgery, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Boris Krischek
- Center for Neurosurgery, Medical Faculty and University Hospital, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
- Department of Neurosurgery , Hôpitaux Robert Schuman , 9 Rue Edward Steichen, 2540, Luxembourg, Luxembourg
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Acceptable Blood Pressure Levels in the Prehospital Setting for Patients with Traumatic Brain Injury: A Multicenter Observational Study. World Neurosurg 2021; 149:e504-e511. [PMID: 33561555 DOI: 10.1016/j.wneu.2021.01.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Safe blood pressure levels in the prehospital setting for patients with traumatic brain injury (TBI) remain unclear. We aimed to investigate the association between prehospital blood pressure and the outcomes of patients with TBI to determine optimal threshold for hypotension that could be considered in the prehospital setting. METHODS Using data from the Japan Trauma Data Bank, we identified adult patients (aged ≥18 years) who experienced severe TBI (maximum head Abbreviated Injury Severity score ≥3) and were transported directly from the scene of the blunt trauma occurrence to the hospital, between 2004 and 2019. We excluded patients with prehospital systolic blood pressure (SBP) levels of <60 and ≥160 mm Hg. Using mixed effects logistic regression models, we investigated the association between prehospital SBP and in-hospital mortality, considering the hospital ID as a random effect variable. In addition, we also conducted a stratified analysis based on age (<60 vs. ≥60 years). RESULTS A total of 34,175 patients (16,114 aged <60 years and 18,061 aged ≥60 years) were eligible for the analyses. Plotting the adjusted odds ratios for in-hospital mortality as a function of SBP produced J-shaped curves. An SBP <110 mm Hg was significantly associated with in-hospital mortality, with an adjusted odds ratio of 1.52 (95% confidence interval: 1.39-1.65). Stratified analyses revealed that the threshold did not differ between the age groups. CONCLUSIONS An SBP <110 mm Hg in the prehospital setting is significantly associated with higher in-hospital mortality.
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Soni KD, Khajanchi M, Raykar N, Sarang B, O'Reilly GM, Dharap S, Cameron P, Sharma N, Howard T, Farrow N, Roy N. Does in-hospital trauma mortality in urban Indian academic centres differ between "office-hours" and "after-hours"? J Crit Care 2020; 62:31-37. [PMID: 33242732 DOI: 10.1016/j.jcrc.2020.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/07/2020] [Accepted: 11/13/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Trauma services within hospitals may vary considerably at different times across a 24 h period. The variable services may negatively affect the outcome of trauma victims. The current investigation aims to study the effect of arrival time of major trauma patients on mortality and morbidity. METHOD Retrospective analysis of the Australia-India Trauma Systems Collaboration (AITSC) registry established in four public university teaching centres in India Based on hospital arrival time, patients were grouped into "Office-hours" and "After-hours". Outcome parameters were compared between the above groups. RESULTS 5536 (68.4%) patients presented "after-hours" (AO) and 2561 (31.6%) during "office-hours" (OH). The in-hospital mortality for "after-hours" and "office-hours" presentations were 12.1% and 11.6% respectively. On unadjusted analysis, there was no statistical difference in the odds of survival for OH versus AH presentations. (OR,1.05, 95% CI 0.9-1.2). Adjusting for potential prognostic factors (injury severity, presence of shock on arrival, referral status, sex, or extremes of age), there was no statistically significant odds of survival for OH versus AH presentations (OR,1.02, 95%CI 0.9-1.2).ICU length of stay and duration of mechanical ventilation was longer in the AH group. CONCLUSION The in-hospital mortality did not differ between trauma patients who arrived during "after-hours" compared to '"office-hours".
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Affiliation(s)
- Kapil Dev Soni
- Critical and Intensive Care, JPN Apex Trauma Centre, AIIMS, New Delhi, India
| | - Monty Khajanchi
- Seth. G. S. Medical College & K.E.M. HospitalParel, Mumbai, India
| | - Nakul Raykar
- Division of Trauma and Emergency Surgery, Brigham and Women's Hospital, Boston, USA
| | - Bhakti Sarang
- Trauma Research Group, WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India
| | - Gerard M O'Reilly
- NHMRC Research, Head of Epidemiology and Biostatistics, National Trauma Research Institute, The Alfred, Melbourne, Australia
| | - Satish Dharap
- Dept of General Surgery, Topiwala National Medical College & B.Y.L. Nair Ch. Hospital, Mumbai, India
| | - Peter Cameron
- The Alfred Hospital, Emergency and Trauma Centre, Prehospital Emergency and Trauma Research, Health Services Research, Australia
| | | | - Teresa Howard
- Central Clinical School, Monash University, Melbourne, Australia-The Burnet Institute, Melbourne, Australia
| | - Nathan Farrow
- Monash University-Alfred Health, National Trauma Research Institute, Patient Safety Review, Safer Care Victoria, Australia
| | - Nobhojit Roy
- Trauma Research Group, WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India; Dept of Global Public Health, Karolinska Institutet, Stockholm, Sweden; School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia.
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18
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Yanagawa Y, Jitsuiki K, Muramatsu KI, Ikegami S, Kushida Y, Nagasawa H, Nishio R, Takeuchi I, Ohsaka H, Oode Y, Omori K. Survey of trauma patients injured by falling or flying objects in Japan based on the Japan Trauma Data Bank. Eur J Trauma Emerg Surg 2020; 48:667-677. [PMID: 33026458 DOI: 10.1007/s00068-020-01519-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/26/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE We retrospectively investigated patients injured by falling/flying objects using the Japan Trauma Data Bank (JTDB). METHODS The study collected information of the JTEB from January 2004 to May 2019. The subjects were divided into two groups: the unexpected accident (UA) group included cases in which the patient was injured by an unexpected accident; the labor accident (LA) group included cases in which the patient was injured at work. RESULTS A total of 1997 patients were enrolled as subjects (UA group, n = 383; LA group, n = 1134). In both groups, head injuries were the most frequent type of injury, followed by chest injuries. The median head abbreviated injury scale of the UA group was significantly higher than that of the LA group. In the UA group, the percentage of female patients, average age, and average TRISS value were significantly greater in comparison to the LA group. The frequency of emergency operations in the UA group was significantly lower in comparison to the LA group. The frequency of head injuries in the UA group was significantly greater than that in the LA group. The frequencies of upper extremity and lower extremity injuries in the UA group were significantly lower than those in the LA group. CONCLUSION This is the first report to analyze trauma patients injured by falling/flying objects using the JTDB. Public health and emergency providers can use this information to anticipate the health-care needs after falling/flying object injuries.
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Affiliation(s)
- Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan.
| | - Kei Jitsuiki
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Ken-Ichi Muramatsu
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Saya Ikegami
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Yoshihiro Kushida
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Hiroki Nagasawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Ryoto Nishio
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Ikuto Takeuchi
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Yasumasa Oode
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Kazuhiko Omori
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
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Kushida Y, Jitsuiki K, Muramatsu KI, Ikegami S, Nagasawa H, Takeuchi I, Ohsaka H, Oode Y, Omori K, Yanagawa Y. A comparison of physician-staffed helicopters and ground ambulances transport for the outcome of severe thoracic trauma patients. Am J Emerg Med 2020; 45:358-360. [PMID: 33039240 DOI: 10.1016/j.ajem.2020.08.088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/22/2020] [Accepted: 08/27/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE We retrospectively investigated prognostic factors for severe thoracic trauma patients evacuated by a physician-staffed helicopter emergency medical service (HEMS) and ground ambulance using the Japan Trauma Data Bank (JTDB). METHODS This study was a retrospective analysis of the JTDB database. The study period was from January 2004 to May 2019. The subjects were divided into two groups, according to the type of transportation: the Heli group included cases transported by the HEMS, while the Ambulance group included cases transported by ground ambulance. RESULTS During the investigation period, a total of 57,872 patients were enrolled as subjects, including 7238 in the Heli group and 50,634 in the Ambulance group. The average age, male ratio, average injury severity score (ISS), average revised trauma score (RTS) and survival ratio were significantly greater in the Heli group than in the Ambulance group. After performing a propensity score-matched analysis, there were no statistical differences concerning the age, sex, ISS, RTS between the two groups. However, the survival ratio in the Heli group remained greater than that in the Ambulance group. When variables that showed statistical significance in the univariate analysis were included in a multivariate analysis, the RTS, transport by the HEMS, age, ISS and female gender were identified as significant predictors of a survival outcome. The HEMS was significantly associated with an increased survival ratio (odds ratio: 1.69; 95% confidence interval: 1.51-1.88) compared with a ground ambulance. CONCLUSION The present study showed that transport by the HEMS improved the survival rate compared to that by a ground ambulance for patients with severe thoracic trauma.
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Affiliation(s)
- Yoshihiro Kushida
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan
| | - Kei Jitsuiki
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan
| | - Ken-Ichi Muramatsu
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan
| | - Saya Ikegami
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan
| | - Hiroki Nagasawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan
| | - Ikuto Takeuchi
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan
| | - Yasumasa Oode
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan
| | - Kazuhiko Omori
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan
| | - Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan.
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20
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Yanagawa Y, Jitsuiki K, Muramatsu KI, Kushida Y, Ikegami S, Nagasawa H, Takeuchi I, Ohsaka H, Omori K, Oode Y. Clinical Investigation of Burn Patients Transported by Helicopter Based on the Japan Trauma Data Bank. Air Med J 2020; 39:464-467. [PMID: 33228895 DOI: 10.1016/j.amj.2020.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/29/2020] [Accepted: 08/20/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We retrospectively investigated the actual conditions of burn patients evacuated by helicopter in comparison to those evacuated by ground ambulance using the Japan Trauma Data Bank. METHODS This study was a retrospective analysis of the data recorded in the Japan Trauma Data Bank between January 2004 and May 2019. After propensity score matching for the method of transportation, the survival rate was compared between the 2 groups. RESULTS During the investigation period, there were 4,627 burn patients (helicopter group, n = 276; ambulance group, n = 4,351). After propensity score matching, there were no significant differences between the 2 groups in any of the assessed variables, and the survival rate did not differ to a statistically significant extent. CONCLUSION After propensity score matching, the survival rate of the helicopter group did not appear to be superior to the ambulance group. Further prospective studies are needed to explore the proper indications for air transportation of burn patients, which could potentially improve outcomes.
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Affiliation(s)
- Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan.
| | - Kei Jitsuiki
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Ken-Ichi Muramatsu
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Yoshihiro Kushida
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Saya Ikegami
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Hiroki Nagasawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Ikuto Takeuchi
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Kazuhiko Omori
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Yasumasa Oode
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
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21
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Lenart EK, Lewis RH, Sharpe JP, Fischer PE, Croce MA, Magnotti LJ. They only come out at night: Impact of time of day on outcomes after penetrating abdominal trauma. Surg Open Sci 2020; 2:1-4. [PMID: 32803149 PMCID: PMC7419659 DOI: 10.1016/j.sopen.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 10/26/2022] Open
Abstract
Background Patients who present at night following penetrating abdominal trauma are thought to have more severe injuries and increased risk for morbidity and mortality. The current literature is at odds regarding this belief. The purpose of this study was to evaluate time of day on outcomes following laparotomy for penetrating abdominal trauma. Methods Patients undergoing laparotomy following penetrating abdominal trauma over a 12-month period at a level I trauma center were stratified by age, sex, severity of shock, injury, operative complexity, and time of day (DAY = 0700-1900, NIGHT = 1901-0659). Outcomes of damage control laparotomy, ventilator days, intensive care unit length of stay, hospital length of stay, morbidity, and mortality were compared between DAY and NIGHT. Results A total of 210 patients were identified: 145 (69%) comprised NIGHT, and 65 (31%) comprised DAY. Overall mortality was 2.9%. Both injury severity and intraoperative transfusions were increased with NIGHT with no difference in morbidity (37% vs 40%, P = 0.63) or mortality (2.1% vs 4.6%, P = 0.31). Adjusting for sex, time of day, injury severity, and operative complexity, only abdominal abbreviated injury severity (odds ratio 1.46; 95% confidence interval 1.07-1.99, P = .019) and operative transfusions (odds ratio 1.18; 95% confidence interval 1.09-1.28, P < .0001) were identified as independent predictors of damage control laparotomy using multivariable logistic regression (area under the curve 0.96). Conclusion The majority of operative penetrating abdominal trauma occurs at night with increased injury burden, more operative transfusions, and increased use of damage control laparotomy with no difference in morbidity and mortality. Outcomes at a fully staffed and operational trauma center should not be impacted by time of day.
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Affiliation(s)
- Emily K Lenart
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Richard H Lewis
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - John P Sharpe
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Peter E Fischer
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Martin A Croce
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Louis J Magnotti
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
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22
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Yanagawa Y, Omori K, Muramatsu KI, Kushida Y, Ikegami S, Nagasawa H, Nishio R, Takeuchi I, Jitsuiki K, Ohsaka H, Oode Y. Prognostic Factors in Trauma Patients Transported by Physician-Staffed Helicopter in Japan: An Investigation Based on the Japan Trauma Data Bank. Air Med J 2020; 39:494-497. [PMID: 33228901 DOI: 10.1016/j.amj.2020.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/23/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We retrospectively investigated prognostic factors for patients evacuated by the physician-staffed helicopter emergency medical service using the Japan Trauma Data Bank. METHODS The study period was from January 2004 to May 2019. The subjects were divided into 2 groups according to the outcome: the survival group and the fatal group. RESULTS A total of 19,370 patients were enrolled as subjects. There were 17,080 patients in the survival group and 2,290 in the fatal group. In a multivariate analysis of factors that showed statistical significance in a univariate analysis, the Revised Trauma Score, age, Injury Severity Score, Maximum Abbreviated Injury Scale (MAX-AIS) for the upper extremity (negative), year of helicopter dispatch, Japan Coma Scale, MAX-AIS for the head, MAX-AIS for the abdomen/pelvis, and MAX-AIS for the spine were identified as significant predictors of a fatal outcome . CONCLUSION This is the first report to investigate the prognostic factors of patients evacuated by helicopter emergency medical service using the Japan Trauma Data Bank. The results suggest that physiological abnormality, age, traumatic anatomic abnormality (other than upper extremity abnormality), and year of helicopter dispatch may be prognostic factors.
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Affiliation(s)
- Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan..
| | - Kazuhiko Omori
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Ken-Ichi Muramatsu
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Yoshihiro Kushida
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Saya Ikegami
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Hiroki Nagasawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Ryota Nishio
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Ikuto Takeuchi
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Kei Jitsuiki
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Yasumasa Oode
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
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Alnajashi SS, Alayed SA, Al-Nasher SM, Aldebasi B, Khan MM. Will surgeries performed at night lead to worse outcomes? Findings from a trauma center in Riyadh. Medicine (Baltimore) 2020; 99:e20273. [PMID: 32769860 PMCID: PMC7593025 DOI: 10.1097/md.0000000000020273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
As surgeries are performed around the clock, the time of surgery might have an impact on outcomes. Our aim is to investigate the impact of daytime and nighttime shifts on surgeons and their performance. We believe that such studies are important to enhance the quality of surgeries and their outcomes and help understand the effects of time of the day on surgeons and the surgeries they perform.A retrospective cohort study was conducted using the database from the King Abdulaziz Medical City trauma center. We selected 330 cases of patients between 2015 and 2018, who underwent a trauma intervention surgery within 24 hours after admission. Patients were aged 15 years and above who underwent 1 or more of the following trauma interventions: neurosurgery, general surgery, plastic surgery, vascular surgery, orthopedics, ophthalmology, and/or otolaryngology. We divided the work hours into 3 shifts: 8 AM to 3:59 PM, 4 PM to 11:59 PM, and midnight to 7:59 AM.Participants' mean age was 31.4 (standard deviation ± 13) years. Most surgeries occurred on weekdays (68.4%). Complications were one and a half times more on weekends, with 5 complicated cases on weekends (1.55%) and 3 (0.9%) on weekdays. Half of all surgeries were performed in the morning (152 cases, 53.15%); 73 surgeries (25.5%) were performed in the evening and 61 (21.3%) were performed late at night. Surgeries performed during late-night shifts were marginally better. Complications occurred in 4 out of 152 morning surgeries (2.6%), 2 out of 73 evening surgeries (2.7%), and only 1 out of 61 late-night surgeries (1.6%). The earlier comparison scored a P-value of >.99, suggesting that patients in morning and evening surgeries were twice more likely to experience complications than late-night surgeries.This study may support previous research that there is little difference in outcomes between daytime and nighttime surgeries. The popular belief that rested physicians are better physicians requires further assessment and research.
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Affiliation(s)
| | | | | | - Bader Aldebasi
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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24
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Aoki M, Abe T, Matsumura Y, Hagiwara S, Saitoh D, Oshima K. The off-hour effect among severe trauma patients: a nationwide cohort study in Japan. Surg Today 2020; 50:1480-1485. [PMID: 32458232 DOI: 10.1007/s00595-020-02027-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess whether there are temporal differences altering the clinical outcomes of severe trauma patients in Japan. METHODS This was a retrospective cohort study that used recorded data from the Japan Trauma Data Bank. Severe trauma patients who had an injury severity score of greater than 16 were included. The hospital arrival time was categorized into daytime (8 a.m.-7:59 p.m.) and nighttime (8 p.m.-7:59 a.m.). The hospital arrival day of the week was categorized into business days and non-business days. The primary outcome was in-hospital mortality. RESULTS A total of 65,136 severe trauma patients were analyzed. In-hospital mortality was 15.6% in the daytime and 14.4% in the nighttime, and 15.5%, and 14.6% on business days and non-business days, respectively. Nighttime was associated with decreased in-hospital mortality compared to daytime (odds ratio = 0.817, 95% confidence interval = 0.764-0.874) and a non-business day was not associated with in-hospital mortality. CONCLUSIONS We did not find a negative off-hour effect on in-hospital mortality among severe trauma patients.
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Affiliation(s)
- Makoto Aoki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.
| | - Toshikazu Abe
- Department of General Medicine, Juntendo University, Tokyo, Japan.,Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
| | - Yosuke Matsumura
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Shuichi Hagiwara
- Department of Emergency Medicine, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
| | - Daizoh Saitoh
- Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Japan
| | - Kiyohiro Oshima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
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